Predictors of highly prevalent brain ischemia in intracerebral hemorrhage

Ravi S. Menon, Richard E. Burgess, Jeffrey J. Wing, M. Christopher Gibbons, Nawar M. Shara, Stephen Fernandez, Annapurni Jayam-Trouth, Laura German, Ian Sobotka, Dorothy Edwards, Chelsea S. Kidwell

Research output: Contribution to journalArticlepeer-review

83 Scopus citations

Abstract

Objective: This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). Methods: Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)-based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. Results: Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p = 0.025), intraventricular hemorrhage (p = 0.019), presence of microbleeds (p = 0.024), and large, early reductions in mean arterial pressure (p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1-month DWI lesions included history of any prior stroke (p = 0.012), presence of 1 or more microbleeds (p = 0.04), black race (p = 0.641), and presence of a DWI lesion at baseline (p = 0.007). Interpretation: This study demonstrates that >1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalAnnals of Neurology
Volume71
Issue number2
DOIs
StatePublished - Feb 2012

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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